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Recent Advances in Carotid Artery Stenting

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Textbook of Catheter-Based Cardiovascular Interventions

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Abstract

Carotid artery stenting (CAS), which has emerged as an alternative therapy to high-risk surgical patients, has become an increasingly important procedure in the optimal management of patients with carotid disease. Current evidence both in symptomatic and in asymptomatic patients suggests that CAS should be performed by skilled operators with formal training and in high-volume centers with a standardized and tailored approach.

A proper tailored approach is based on a profound knowledge of available devices and has been emphasized as the key to achieving a safe practice. Emerging technologies and further innovations pursuing stroke prevention are having wider application and their clinical impact is starting to be evaluated. However, technology advancements must be considered as adjunctive tools in a careful procedural strategy possibly including preprocedural evaluation of CAS technical risks, use of cerebral protection devices, stent selection, and proper management of CAS complications. Following this approach, CAS is intended to be at least as safe and effective as surgical endarterectomy.

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References

  1. Robertson JT. Carotid endarterectomy: a Saga of clinical science, personalities, and evolving technology. Willis Lect Stroke. 1998;29:2435–41.

    Article  CAS  Google Scholar 

  2. Roubin GS, Iyer S, Halkin A, Vitek J, Brennan C. Realizing the potential of carotid artery stenting proposed paradigms for patient selection and procedural technique. Circulation. 2006;113:2021–30.

    Article  PubMed  Google Scholar 

  3. Yusuf S, Sleight P, Pogue J, et al. Effects of an angiotensin-converting-enzyme inhibitor, ramipril, on cardiovascular events in high-risk patients. The heart outcomes prevention evaluation study investigators. N Engl J Med. 2000;342:145–53.

    Article  CAS  PubMed  Google Scholar 

  4. Collins R, Armitage J, Parish S, et al.; Heart Protection Study Collaborative Group. Effects of cholesterol-lowering with simvastatin on stroke and other major vascular events in 20536 people with cerebrovascular disease or other high-risk condi-tions. Lancet. 2004;363:757–67.

    Google Scholar 

  5. Halliday A, Mansfield A, Marro J, et al.; MRC Asymptomatic Carotid Surgery Trial (ACST) Collaborative Group. Prevention of disabling and fatal strokes by successful carotid endarterectomy in patients without recent neurological symptoms: ran-domised controlled trial. Lancet. 2004;363:1491–502.

    Google Scholar 

  6. Yadav JS, Wholey MH, Kuntz RE, et al.; Stenting and Angioplasty with Protection in Patients at High Risk for Endarterecto-my Investigators. Protected carotid-artery stenting versus endarterectomy in high-risk patients. N Engl J Med. 2004;351:1493–501.

    Google Scholar 

  7. Mas JL, Chatellier G, Beyssen B, et al.; EVA-3S Investigators. Endarterectomy versus stenting in patients with symptomatic severe carotid stenosis. N Engl J Med. 2006;355:1660–71.

    Google Scholar 

  8. Mas JL, Trinquart L, Leys D, et al.; EVA-3S Investigators. Endarterectomy versus angioplasty in patients with symptomatic severe carotid Stenosis (EVA-3S) trial: results up to 4 years from a randomised, multicentre trial. Lancet Neurol. 2008;7:885–92.

    Google Scholar 

  9. Ringleb PA, Allenberg J, Brückmann H, et al.; SPACE Collaborative Group. 30 day results from the SPACE trial of stent-protected angioplasty versus carotid endarterectomy in symptomatic patients: a randomised non-inferiority trial. Lancet. 2006;368:1239–47.

    Google Scholar 

  10. Ederle J, Dobson J, Featherstone RL, et al.; International Carotid Stenting Study investigators. Carotid artery stenting com-pared with endarterectomy in patients with symptomatic carotid stenosis (International Carotid Stenting Study): an interim analysis of a randomised controlled trial. Lancet. 2010;375:985–97.

    Google Scholar 

  11. Brott TG, Hobson RW 2nd, Howard G, et al.; CREST Investigators. Stenting versus endarterectomy for treatment of carotid-artery stenosis. N Engl J Med. 2010;363:11–23.

    Google Scholar 

  12. Reiff T, Eckstein HH, Amiri H, et al.; SPACE-2 Study Group. Modification of SPACE-2 study design. Int J Stroke. 2014;9:E12–3.

    Article  CAS  PubMed  Google Scholar 

  13. Halliday A, Bulbulia R, Gray W, et al.; ACST-2 Collaborative Group. Status update and interim results from the asymptomat-ic carotid surgery trial-2 (ACST-2). Eur J Vasc Endovasc Surg. 2013;46:510–8.

    Google Scholar 

  14. Rosenfield K, Matsumura JS, Chaturvedi S, Riles T, Ansel GM, Metzger DC, Wechsler L, Jaff MR, Gray W, ACT I Investigators. Randomized trial of stent versus surgery for asymptomatic carotid stenosis. N Engl J Med. 2016;374:1011–20.

    Article  CAS  PubMed  Google Scholar 

  15. Nedeltchev K, Pattynama PM, Biaminoo G, et al.; DEFINE Group. Standardized definitions and clinical endpoints in carotid artery and supra-aortic trunk revascularization trials. Catheter Cardiovasc Interv. 2010;76:333–44.

    Google Scholar 

  16. Krapf H, Nägele T, Kastrup A, et al. Risk factors for periprocedural complications in carotid artery stenting without filter protection: a serial diffusion-weighted MRI study. J Neurol. 2006;253:364–71.

    Article  PubMed  Google Scholar 

  17. Aronow HD, Shishehbor M, Davis DA, et al. Leukocyte count predicts microembolic Doppler signals during carotid stenting: a link between inflammation and embolization. Stroke. 2005;36:1910–4.

    Article  PubMed  Google Scholar 

  18. Verhoeven BA, de Vries JP, Pasterkamp G, et al. Carotid atherosclerotic plaque characteristics are associated with micro-embolization during carotid endarterectomy and procedural outcome. Stroke. 2005;36:1735–40.

    Article  CAS  PubMed  Google Scholar 

  19. Biasi GM, Froio A, Diethrich EB, et al. Carotid plaque echolucency increases the risk of stroke in carotid stenting: the imaging in carotid angioplasty and risk of stroke (ICAROS) study. Circulation. 2004;110:756–62.

    Article  PubMed  Google Scholar 

  20. de Campos Martins EC, Cremonesi A, Castriota F. Proposed practical anatomical-procedural classification systems for evaluating carotid lesions and carotid artery stenting. EuroIntervention. 2012;8:607–16.

    Article  PubMed  Google Scholar 

  21. Cremonesi A, Roffi M, Carvalho de Campos Martins E, et al. Carotid Artery Stenting (chapter 42). In: Serruys PW, Wijns W, Vahanian A, editors. Percutaneous interventional cardiovascular medicine. The PCR-EAPCI textbook. Toulouse: PCR Publishing; 2012.

    Google Scholar 

  22. Angelini A, Reimers B, Della Barbera M, et al. Cerebral protection during carotid artery stenting: collection and histopatho-logic analysis of embolized debris. Stroke. 2002;33:456–61.

    Article  PubMed  Google Scholar 

  23. Crawley F, Clifton A, Buckenham T, et al. Comparison of hemodynamic cerebral ischemia and microembolic signals detected during carotid endarterectomy and carotid angioplasty. Stroke. 1997;28:2460–4.

    Article  CAS  PubMed  Google Scholar 

  24. Al-Mubarak N, Roubin GS, Vitek JJ, et al. Effect of the distal-balloon protection system on microembolization during carotid stenting. Circulation. 2001;104:1999–2002.

    Article  CAS  PubMed  Google Scholar 

  25. Kastrup A, Gröschel K, Krapf H, et al. Early outcome of carotid angioplasty and stenting with and without cerebral protec-tion devices: a systematic review of the literature. Stroke. 2003;34:813–9.

    Article  PubMed  Google Scholar 

  26. Reimers B, Schlüter M, Castriota F, et al. Routine use of cerebral protection during carotid artery stenting: results of a multicenter registry of 753 patients. Am J Med. 2004;116:217–22.

    Article  PubMed  Google Scholar 

  27. Sprouse LR 2nd, Peeters P, Bosiers M. The capture of visible debris by distal cerebral protection filters during carotid artery stenting: is it predictable? J Vasc Surg. 2005;41:950–5.

    Article  PubMed  Google Scholar 

  28. Cremonesi A, Setacci C, Manetti R, et al. Carotid angioplasty and stenting: lesion related treatment strategies. EuroIntervention. 2005;1:289–95.

    PubMed  Google Scholar 

  29. Zahn R, Mark B, Niedermaier N, et al. Arbeitsgemeinschaft Leitende Kardiologische Krankenhausärzte (ALKK). Embolic protection devices for carotid artery stenting: better results than stenting without protection? Eur Heart J. 2004;25:1550–8.

    Article  PubMed  Google Scholar 

  30. Castriota F, Cremonesi A, Manetti R, et al. Impact of cerebral protection devices on early outcome of carotid stenting. J Endovasc Ther. 2002;9:786–92.

    PubMed  Google Scholar 

  31. Mas JL, Chatellier G, Beyssen B, EVA-3S Investigators. Carotid angioplasty and stenting with and without cerebral protec-tion: clinical alert from the Endarterectomy versus angioplasty in patients with symptomatic severe carotid Stenosis (EVA-3S) trial. Stroke. 2004;35:e18–20.

    PubMed  CAS  Google Scholar 

  32. Wholey MH, Al-Mubarek N, Wholey MH. Updated review of the global carotid artery stent registry. Catheter Cardiovasc Interv. 2003;60:259–66.

    Article  PubMed  Google Scholar 

  33. Whitlow PL, Lylyk P, Londero H, et al. Carotid artery stenting protected with an emboli containment system. Stroke. 2002;33:1308–14.

    Article  PubMed  Google Scholar 

  34. Rabe K, Sugita J, Gödel H, et al. Flow-reversal device for cerebral protection during carotid artery stenting--acute and long-term results. J Interv Cardiol. 2006;19:55–62.

    Article  PubMed  Google Scholar 

  35. Bersin RM, Stabile E, Ansel GM, et al. A meta-analysis of proximal occlusion device outcomes in carotid artery stenting. Catheter Cardiovasc Interv. 2012;80:1072–8.

    Article  PubMed  Google Scholar 

  36. Diederich KW, Scheinert D, Schmidt A, et al. First clinical experiences with an endovascular clamping system for neuro-protection during carotid stenting. Eur J Vasc Endovasc Surg. 2004;28:629–33.

    Article  PubMed  Google Scholar 

  37. Coppi G, Moratto R, Silingardi R, et al. PRIAMUS – proximal flow blockage cerebral protectIon during carotid stenting: results from a multicenter Italian registry. J Cardiovasc Surg. 2005;46:219–27.

    CAS  Google Scholar 

  38. Pinter L, Ribo M, Loh C, et al. Safety and feasibility of a novel transcervical access neuroprotection system for carotid artery stenting in the PROOF study. J Vasc Surg. 2011;54:1317–23.

    Article  PubMed  Google Scholar 

  39. Reimers B, Corvaja N, Moshiri S, et al. Cerebral protection with filter devices during carotid artery stenting. Circulation. 2001;104:12–5.

    Article  CAS  PubMed  Google Scholar 

  40. Nerla R, Castriota F, Micari A, Sbarzaglia P, Secco GG, Ruffino MA, de Donato G, Setacci C, Cremonesi A. Carotid artery stenting with a new-generation double-mesh stent in three high-volume Italian centres: clinical results of a multidisciplinary approach. EuroIntervention. 2016;12:e677–83.

    Article  PubMed  Google Scholar 

  41. Bosiers M, Deloose K, Torsello G, Scheinert D, Maene L, Peeters P, Müller-Hülsbeck S, Sievert H, Langhoff R, Bosiers M, Setacci C. The CLEAR-ROAD study: evaluation of a new dual layer micromesh stent system for the carotid artery. EuroIntervention. 2016;12:e671–6.

    Article  PubMed  Google Scholar 

  42. Musialek P, Mazurek A, Trystula M, Borratynska A, Lesniak-Sobelga A, Urbanczyk M, Banys RP, Brzychczy A, Zajdel W, Partyka L, Zmudka K, Podolec P. Novel PARADIGM in carotid revascularisation: prospective evaluation of all-comer peRcutaneous cArotiD revascularisation in symptomatic and increased-risk asymptomatic carotid artery stenosis using CGuard™ MicroNet-covered embolic prevention stent system. EuroIntervention. 2016;12:e658–70.

    Article  PubMed  Google Scholar 

  43. Schofer J, Musiałek P, Bijuklic K, et al. A prospective, multicenter study of a novel mesh-covered carotid stent: the CGuard CARENET trial (carotid embolic protection using MicroNet). JACC Cardiovasc Interv. 2015;8:1229–34.

    Article  PubMed  Google Scholar 

  44. Bosiers M, de Donato G, Deloose K, et al. Does free cell area influence the outcome in carotid artery stenting? Eur J Vasc Endovasc Surg. 2007;33:135–41.

    Article  CAS  PubMed  Google Scholar 

  45. Castriota F, de Campos Martins EC, Setacci C, et al. Cutting balloon angioplasty in percutaneous carotid interventions. J Endovasc Ther. 2008;15:655–62.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Interventional Cardiology Unit GVM Care & Research, Maria Cecilia Hospital, Via Corriera 1, 48033, Cotignola (RA), Italy

    Roberto Nerla MD, Kumara Ganesan MD, Antonio Micari MD, PhD, Fausto Castriota MD & Alberto Cremonesi MD FESC

Authors
  1. Roberto Nerla MD
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  2. Kumara Ganesan MD
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  3. Antonio Micari MD, PhD
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  4. Fausto Castriota MD
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  5. Alberto Cremonesi MD FESC
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Corresponding author

Correspondence to Roberto Nerla MD .

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Editors and Affiliations

  1. Middle German Heart Center and Health Care Center Bitterfeld-Wolfen, gGmbH, Bitterfeld-Wolfen, Germany

    Peter Lanzer

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Nerla, R., Ganesan, K., Micari, A., Castriota, F., Cremonesi, A. (2018). Recent Advances in Carotid Artery Stenting. In: Lanzer, P. (eds) Textbook of Catheter-Based Cardiovascular Interventions. Springer, Cham. https://doi.org/10.1007/978-3-319-55994-0_74

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  • DOI: https://doi.org/10.1007/978-3-319-55994-0_74

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  • Online ISBN: 978-3-319-55994-0

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